Cytoreductive surgery in patients with oligometastatic prostate cancer. Systematic review of the scientific literature.

INTRODUCTION: Interest in oligometastatic prostate cancer has spiked due to the emergence of new evidence regarding more specific and accurate imaging, and the wider use of minimally invasive techniques. Nevertheless, the optimal management of this pathology is yet to be determined. OBJECTIVE: Assess the efficacy and safety of cytoreductive surgery in patients suffering from oligometastatic prostate cancer. EVIDENCE GATHERING: Systematic review of the scientific literature (01/01/2010-31/12/2021) within the MedLine, Embase, Cochrane Library, Cinahl, Scopus, Spanish Healthcare Technology Assessment Agencies (AETS, Agencias de Evaluación de Tecnologías Sanitarias) and ClinicalTrials.gov databases. The keywords used were prostatectomy, prostatic neoplasm, radical prostatectomy; the free search terms were prostatectomy and oligometastatic prostate. The inclusion criteria comprised studies on patients with oligometastatic prostate cancer who had been operated on using radical cytoreductive prostatectomy. EVIDENCE SYNTHESIS: The systematic review included 4 observational studies, 2 clinical trials, and 2 case series, of moderate quality. The results observed suggest that oligometastatic prostate cancer patients who had undergone cytoreductive prostate surgery obtained a benefit in terms of efficacy. Conversely, the majority of these studies showed a reduction in the number of localized complications, when compared to the best systemic treatments. CONCLUSIONS: Cytoreductive surgery in this group of patients is a safe procedure that reduces the incidence of localized complications and that presents promising results with regard to survival rates. To date, the lack of prospective trials limits the use of this therapeutic option to experimental environments.

[Efficacy, effectiveness and safety of the adjuvanted influenza vaccine in the population aged 65 or over]. / Eficacia, efectividad y seguridad de la vacuna antigripal adyuvada en población de 65 o más años de edad.

Most of the complications and deaths related to seasonal flu occur in the elderly population (≥65 years) with comorbidities, and the influenza vaccine is the most effective way to prevent them. Immunization is less effective in older adults due to immunosenescence. MF59-adjuvanted vaccines, designed to improve the magnitude, persistence and amplitude of the immune response in elderly people, have been used in clinical practice since 1997 in their trivalent formulation and, since 2020, in their tetravalent formulation. Data from various studies show that these vaccines are not only safe for all age groups, with a reactogenicity profile similar to that of the conventional vaccine, but also that they are especially effective in boosting the immune response in the population aged 65 or over by increasing antibody titers after vaccination and significantly reducing the risk of hospital admission. Adjuvanted vaccines have been shown to provide cross-protection against heterologous strains and to be as effective as the high-dose vaccine in the population aged 65 or over. In this review, the scientific evidence on the efficacy and effectiveness of the MF59-adjuvanted vaccine in real clinical practice in people ≥65 years of age is analyzed through a narrative and descriptive review of the literature with data from clinical trials, observational studies and systematic reviews or meta-analysis.

[Susceptibility to antimicrobial agents of rapidly growing mycobacteria]. / Sensibilidad a los antimicrobianos de micobacterias de crecimiento rápido.

Rapidly growing mycobacteria are often associated with human diseases. We investigated the in vitro susceptibilities of 40 isolates to six antimicrobial agents: 17 Mycobacterium fortuitum, 11 M. chelonae and 12 M. abscessus isolated from several human sources: 29 respiratory secretions, 5 cutaneous abscesses, 4 corneal ulcers and 2 urine samples of patients treated at "Hospital Puerta del Mar" (Cádiz). Susceptibility studies were determined by the broth microdilution method for amikacin, clarithromycin, ciprofloxacin, levofloxacin, imipenem and cefoxitin. Results suggest that amikacin is the most effective antimicrobial agent for treating infections due to rapidly growing mycobacteria. Clarithromycin and imipenem show good activity against M. fortuitum and M. abscessus, but not against M. chelonae. Quinolones are only effective against M. fortuitum. It's important to identify, in rapidly growing mycobacteria infections, the etiologic agent to determine correct treatment.

[Antifungal susceptibility of Acremonium species using E-test and Sensititre]. / Sensibilidad a antifúngicos de especies de Acremonium mediante los metodos E-test y Sensititre.

Filamentous fungi have become a common cause of severe infections, especially in immunocompromised patients. In recent years, the number and diversity of the infections caused by Acremonium species have increased and numerous species have been implicated. As is the case for most emerging pathogens, the optimal therapeutic approach to Acremonium species remains to be determined. We used two methods to determine the in vitro susceptibility to amphotericin B, itraconazole and fluconazole for 15 clinical isolates of eight different species of Acremonium. The MICs were determined according to protocol M38-A of the National Committee for Clinical Laboratory Standards (NCCLS) document, using the Sensititre and E-test microdilution methods. Amphotericin B was effective in vitro for few species using the Sensititre method. However, high MICs were obtained with E-test. Fluconazole and itraconazole were ineffective according to both methods. Acremonium species are generally resistant to the most commonly used antifungal agents. Consequently, Acremonium susceptibility testing is recommended to assist in choosing adequate treatment of infections caused by this filamentous fungus.

[Retinal detachment in preeclampsia and HELLP Syndrome]. / Desprendimiento de retina en un caso de preeclampsia y Síndrome HELLP.

CASE REPORT: We report the case of a 33-year-old pregnant female with severe preeclampsia who developed serous retinal detachments and HELLP syndrome. DISCUSSION: Following delivery by Caesarian section, there was spontaneous resolution of the serous retinal detachments, with residual pigmentary changes of the retinal pigment epithelium. The patient recovered normal vision (Arch Soc Esp Oftalmol 2003; 78: 335-338).

Safety and immunogenicity of 13-valent pneumococcal conjugate vaccine in infants: a meta-analysis.

Pneumococcal infections are a major cause of morbidity and mortality worldwide. Pneumococcal conjugate vaccines represent major progress in the prevention of invasive pneumococcal disease in the paediatric population. We performed a meta-analysis, in accordance with the PRISMA statement, in order to assess the immunogenicity and safety of 13-valent pneumococcal conjugate vaccines in infants. A literary search was conducted using electronic databases and specialized journals were searched manually. Inclusion criteria were: clinical trials with infants vaccinated with 13-valent pneumococcal conjugate, compared to 7-valent vaccine. We recorded the results in terms of the immunogenicity and safety of the vaccines. The quality of the studies included was assessed using the CASP and Jadad checklists. We included nine randomized clinical trials of 258 potentially relevant references in the meta-analysis. The studies included had high-moderate quality. Both vaccines were well tolerated in all groups of infants, and most local reactions and systemic events were of mild or medium intensity and typical of any injected vaccine. All studies included in the meta-analysis showed high immunogenicity for both pneumococcal vaccines in all tested serotypes. An anti-polysaccharide antibody concentration of ≥0.35 µg/mL was achieved in at least 89% of the infants. Our results suggest that the 13-valent pneumococcal conjugate vaccine has a similar safety profile, and is as effective as, the 7-valent vaccine in the prevention of invasive pneumococcal disease caused by the seven common serotypes, and could provide expanded protection against the six additional serotypes.

Cirugía citorreductora en pacientes con cáncer de próstata oligometastásico. Revisión sistemática de la literatura científica / Cytoreductive surgery in patients with oligometastatic prostate cancer. systematic review of the scientific literature

Introducción La aparición de pruebas de imagen más específicas y sensibles, junto con el empleo cada vez más extendido de técnicas mínimamente invasivas, ha centrado el interés urológico sobre el cáncer de próstata oligometastásico. A pesar de esto, aún queda por determinar el manejo óptimo de esta patología. Objetivo Evaluar la eficacia y seguridad de la cirugía citorreductora en pacientes con cáncer de próstata oligometastásico. Adquisición de la evidencia Revisión sistemática de la literatura científica (01/01/2010-31/12/2021) en las bases de datos Medline, Embase, Cochrane Library, CINAHL, Scopus, Agencias de Evaluación de Tecnologías Sanitarias y ClinicalTrials.gov. Los descriptores utilizados han sido prostatectomy, prostatic neoplasm, radical prostatectomy, y los términos de búsqueda libre prostatectomy y oligomestastasicprostate. Los criterios de inclusión fueron estudios con pacientes con cáncer de próstata oligometastásico e intervenidos mediante prostatectomía radical citorreductora (CRP). Síntesis de la evidencia La revisión sistemática incluyó cuatro estudios observacionales, dos ensayos clínicos y dos series de casos, de calidad moderada. Los resultados observados sugieren un beneficio en cuanto a eficacia en aquellos pacientes oligometastásico sometidos a una cirugía de próstata citorreductora. Por otro lado, la mayoría de estos estudios revelan una reducción en el número de las complicaciones locales cuando se compara con los mejores tratamientos sistémicos. Conclusiones La cirugía citorreductora en este grupo de pacientes, es un procedimiento seguro que reduce las complicaciones locales, que ofrece resultados prometedores en cuanto a supervivencia. Hasta la fecha, la falta de ensayos prospectivos limita el papel de esta opción terapéutica a entornos experimentales (AU)

Introduction Interest in oligometastatic prostate cancer has spiked due to the emergence of new evidence regarding more specific and accurate imaging, and the wider use of minimally invasive techniques. Nevertheless, the optimal management of this pathology is yet to be determined. Objective Assess the efficacy and safety of cytoreductive surgery in patients suffering from oligometastatic prostate cancer. Evidence gathering Systematic review of the scientific literature (01/01/2010-31/12/2021) within the MedLine, Embase, Cochrane Library, Cinahl, Scopus, Spanish Healthcare Technology Assessment Agencies (AETS, Agencias de Evaluación de Tecnologías Sanitarias) and ClinicalTrials.gov databases. The keywords used were prostatectomy, prostatic neoplasm, radical prostatectomy; the free search terms were prostatectomy and oligometastaticprostate. The inclusion criteria comprised studies on patients with oligometastatic prostate cancer who had been operated on using radical cytoreductive prostatectomy. Evidence synthesis The systematic review included 4 observational studies, 2 clinical trials, and 2 case series, of moderate quality. The results observed suggest that oligometastatic prostate cancer patients who had undergone cytoreductive prostate surgery obtained a benefit in terms of efficacy. Conversely, the majority of these studies showed a reduction in the number of localized complications, when compared to the best systemic treatments. Conclusions Cytoreductive surgery in this group of patients is a safe procedure that reduces the incidence of localized complications and that presents promising results with regard to survival rates. To date, the lack of prospective trials limits the use of this therapeutic option to experimental environments (AU)

[Assessment of the MF59-adjuvanted pandemic influenza A/H1N1 vaccine. Systematic review of literature]. / Evaluación de la vacuna pandémica antigripal A/H1N1 adyuvada MF59. Revisión sistemática de la literatura.

OBJECTIVE: To assess the efficacy and safety of MF59-adjuvanted pandemic influenza A/H1N1 vaccine in children. METHODS: A systematic review of the literature was performed after searching the MedLine and Embase electronic databases, and manual search in specialties journals, with MeSH terms and and free terms. Inclusion criteria were clinical trials with children vaccinated with MF59-adjuvanted influenza A/H1N1 vaccine, compared with other vaccines doses with/without MF59-adjuvanted. The immunogenicity and safety of the vaccine was recorded. The quality of the studies included was assessed by CASPe checklist. RESULTS: Four clinical trials with moderate quality were selected. The local and systemic adverse effects were rare and mild, with no differences between groups. Seroconversion and seroprotection levels were higher with MF59-adjuvanted vaccines. Antibody titres were also higher with the adjuvant vaccines. CONCLUSIONS: The adjuvant vaccine has a good efficacy and safety profile. The adverse effects that may occur are common and appear similarly in both vaccination groups.

[Assessment of the PCA3 test for prostate cancer diagnosis: a systematic review and meta-analysis]. / Evaluación del test PCA3 para el diagnóstico de cáncer de próstata: revisión sistemática y metanálisis.

OBJECTIVE: To assess the efficacy of diagnostic techniques based on PCA3 gene for early detection of prostate cancer. We carried out a systematic review of scientific literature and subsequent meta-analysis. MATERIAL AND METHODS: A literature search (2000-09) in MEDLINE, EMBASE, Cochrane Library, CRD, ECRI, Hayes databases and journals of Cancer and Urology. MESH terms used were "Prostatic Neoplasms", Prostate-Specific Antigen", "Antigens, Neoplasm", "Sensitivity and Specificity", "Predictive Value of Tests", and free terms "upm3", "PCA3", "dd3", "aptima PCA3" and "prostate cancer antigen 3". Patients were adults. The intervention was to determine the PCA3 gene, from urine samples for diagnosis of prostate cancer. The quality of the studies was checked according to QUADAS criteria. We calculated diagnostic accuracy rates and developed a meta-analysis to synthesize results. RESULTS: 14 studies of diagnostic tests were selected, with moderate-high quality. The sensitivity was between 46.9% and 82.3%, specificity ranged from 56.3% to 89%, positive predictive value had a range of 59.4-97.4% and negative predictive value 87.8-98%. The meta-analysis detected the existence of a threshold effect and heterogeneity between studies. Global sensitivity values was 0.85 [CI 0.84-0.87], specificity 0.96 [CI 0.96-0.97], positive likelihood ratio 22.21 [CI 15.12-32.63], and negative of 0.15 [CI 0.13-0.18]. CONCLUSIONS: Detection techniques have acceptable diagnostic accuracy rates for using in the diagnosis of prostate cancer.

[Evaluation of rapid methods for detecting Streptococcus pyogenes. Systematic review and meta-analysis]. / Evaluación de los métodos rápidos para la detección de Streptococcus pyogenes. Revisión sistemática y metaanálisis.

INTRODUCTION: Streptococcal pharyngitis is one of the most frequent reasons for consultations in primary and paediatric care. An inadequate treatment could cause adverse effects and bacterial resistance. The rapid antigen tests are an important advance, enabling the diagnosis of infection by Streptococcus pyogenes to be diagnosed in a few minutes. The aim of this review is to assess the rapid antigen-detection test in the diagnosis of S. pyogenes from throat samples. MATERIAL AND METHODS: Systematic review and meta-analysis (2000-09). Source database: MedLine, Embase, Cochrane Library, Cinahl, CRD, ECRI, Hayes and HTA's agencies. The quality of included studies was measured according to Quadas's criteria. The diagnostic validity indices have been calculated. A meta-analysis was performed in order to synthesize the results of the different evaluated studies. RESULTS: Twenty four studies were included. The quality was moderate. The sensitivity ranged between 65.6% and 96.4%; specificity from 68.7%-99.3%; the positive predictive value was between 59.4%-97.4%; and the negative predictive value from 87.8%-98%. The meta-analysis determined an overall sensitivity of 0.85 [95% CI, 0.84-0.87], specificity was 0.96 [95% CI, 0.96-0.97], likelihood ratio (+) 22.21 [95% CI, 15.12-32.63], and likelihood ratio (-) 0.15 [95% CI, 0.13-0.18]. The rapid antigen-detection test demonstrated a good diagnostic performance. CONCLUSIONS: Rapid tests offer good accuracy for use as diagnostic method, however, these devices have to be complemented with the microbiological culture, because there are false positive and negative results.

[Erectile dysfunction in patients with prostate cancer who have undergone surgery: Systematic review of literature]. / Disfunción eréctil en pacientes intervenidos de cáncer de próstata. Revisión sistemática de la literatura médica.

OBJECTIVE: To assess erectile dysfunction in patients with prostate cancer undergoing surgery by radical prostatectomy, laparoscopic prostatectomy or robotic prostatectomy. MATERIAL AND METHODS: Systematic Review of literature based on a search strategy (2000-10) in MedLine, Embase, Cochrane Library, CRD, ECRI, and Hayes. Mesh terms used were Prostatectomy, "Prostatic Neoplasm, Transuretral Resection Prostate, Impotence and as free terms erectile dysfunction and prostatectomy. Studies included patients with prostate cancer underwent by prostatectomy radical with open surgery (retropubic), laparoscopic or robotic surgery. RESULTS: Ten observational studies with moderate quality and 29 case series with low quality were selected. Observational studies showed lower percentages of erectile dysfunction after intervention in the patients underwent robotic surgery (3-51%). Radical surgery (36-91%) and laparoscopic surgery showed higher values of impotence. In the studies that compared surgery versus radiotherapy, the results were better for radiotherapy (3-72% erectile dysfunction). In the case series, lower percentages of erectile dysfunction were shown in patients underwent to robotic surgery (22%), the following was for laparoscopic surgery (40%) and open radical prostatectomy (41.4%). CONCLUSIONS: This result should be considered with caution because of the low methodological quality of the studies included. However, the different surgical techniques assessed showed similar effects in the two types of studies included and we found that robotic surgery presented lower percentages of sexual impotence.

Evaluación del test PCA3 para el diagnóstico de cáncer de próstata: revisión sistemática y metanálisis / Assessment of the PCA3 test for prostate cancer diagnosis: A systematic review and meta-analysis

Objetivos: Evaluar la eficacia de las técnicas diagnósticas basadas en el gen PCA3 para el diagnóstico del cáncer de próstata. Para ello, se ha realizado una revisión sistemática de la literatura científica y posterior metanálisis. Material y métodos: Búsqueda bibliográfica (2000–09) en MedLine, Embase, Cochrane Library, CRD, ECRI, Hayes y en revistas especializadas de Cáncer y Urología. Se utilizaron los descriptores «Prostatic Neoplasms», «Prostate-Specific Antigen», «Antigens, Neoplasm», «Sensitivity and Specificity», «Predictive Value of Tests» y términos libres «upm3», «pca3», «dd3», «aptima pca3» y «prostate cancer antigen 3». La población eran adultos y la intervención consistía en la determinación del gen PCA3, a partir de muestras de orina, para el diagnóstico de cáncer de próstata. La calidad de los estudios se analizó según los criterios QUADAS. Se calcularon los índices de validez diagnóstica y se elaboró un metanálisis para sintetizar los resultados. Resultados: Se incluyeron 14 estudios de pruebas diagnósticas, de calidad moderada-alta. La sensibilidad estuvo comprendida entre 46,9–82,3%; la especificidad osciló entre 56,3–89%; el valor predictivo positivo tuvo un rango de 59,4–97,4%; y el valor predictivo negativo entre 87,8–98%. El metanálisis detectó la existencia de efecto umbral y de heretogeneidad entre los estudios, ofreciendo valores de sensibilidad global de 0,85 (IC 0,84–0,87), especificidad de 0,96 (IC 0,96–0,97), cociente de probabilidad positivo de 22,21 (IC 15,12–32,63) y negativo de 0,15 (IC 0,13–0,18). Conclusiones: Las técnicas de detección presentan aceptables índices de validez diagnóstica para poder usarlas en el diagnóstico de cáncer de próstata (AU)

Objective: To assess the efficacy of diagnostic techniques based on PCA3 gene for early detection of prostate cancer. We carried out a systematic review of scientific literature and subsequent meta-analysis. Material and methods: A literature search (2000–09) in MEDLINE, EMBASE, Cochrane Library, CRD, ECRI, Hayes databases and journals of Cancer and Urology. MESH terms used were "Prostatic Neoplasms", Prostate-Specific Antigen", "Antigens, Neoplasm", "Sensitivity and Specificity", "Predictive Value of Tests", and free terms "upm3", "PCA3", "dd3", "aptima PCA3" and "prostate cancer antigen 3". Patients were adults. The intervention was to determine the PCA3 gene, from urine samples for diagnosis of prostate cancer. The quality of the studies was checked according to QUADAS criteria. We calculated diagnostic accuracy rates and developed a meta-analysis to synthesize results. Results: 14 studies of diagnostic tests were selected, with moderate-high quality. The sensitivity was between 46.9% and 82.3%, specificity ranged from 56.3% to 89%, positive predictive value had a range of 59.4–97.4% and negative predictive value 87.8–98%. The meta-analysis detected the existence of a threshold effect and heterogeneity between studies. Global sensitivity values was 0.85 [CI 0.84–0.87], specificity 0.96 [CI 0.96–0.97], positive likelihood ratio 22.21 [CI 15.12–32.63], and negative of 0.15 [CI 0.13–0.18]. Conclusions: Detection techniques have acceptable diagnostic accuracy rates for using in the diagnosis of prostate cancer (AU)

Disfunción eréctil en pacientes intervenidos de cáncer de próstata. Revisión sistemática de la literatura médica / Erectile dysfunction in patients with prostate cancer who have undergone surgery: Systematic review of literature

Objetivo: Evaluar la aparición de la disfunción eréctil en pacientes con cáncer de próstata sometidos a prostatectomía radical (PR) retropúbica, prostatectomía laparoscópica y/o prostatectomía robótica. Material y métodos: Revisión sistemática de la literatura médica mediante búsqueda bibliográfica (2000–2010) en MedLine, Embase, Cochrane Library, Center for Review Dissemination, ECRI y Hayes. Los términos Mesh fueron «Prostatectomy», «Prostatic neoplasm», «Transuretral resection prostate», «Impotence» y los términos libres fueron «erectile dysfunction» y «prostatectomy». Los estudios incluían pacientes con cáncer de próstata intervenidos para la extirpación de la glándula mediante cirugía abierta (retropúbica), laparoscópica o robótica. Resultados: Se seleccionaron diez estudios observacionales de calidad moderada y 29 series de casos de baja calidad. Los estudios observacionales presentaban los menores porcentajes de disfunción eréctil en pacientes intervenidos mediante cirugía robótica (3–51%). La PR retropúbica (36–91%) y la laparoscópica registraban cifras superiores de aparición de impotencia. Los estudios que comparaban intervenciones, cirugía y radioterapia obtenían con las radiaciones menores índices de disfunción sexual (3–72%). En las series de casos, los menores porcentajes de disfunción eréctil acontecieron en pacientes con cirugía robótica (22%), seguido de cirugía laparoscópica (40%) y de PR retropúbica (41,4%). Conclusiones: Los resultados, aunque deben interpretarse con cautela dada la limitada calidad de los estudios, presentan efectos similares en la evaluación de las diferentes técnicas quirúrgicas, observándose que la cirugía robótica registra los menores porcentajes en relación con la aparición de impotencia sexual (AU)

Objective: To assess erectile dysfunction in patients with prostate cancer undergoing surgery by radical prostatectomy, laparoscopic prostatectomy or robotic prostatectomy. Material and methods: Systematic Review of literature based on a search strategy (2000–10) in MedLine, Embase, Cochrane Library, CRD, ECRI, and Hayes. Mesh terms used were 'Prostatectomy', 'Prostatic Neoplasm', 'Transuretral Resection Prostate', 'Impotence' and as free terms 'erectile dysfunction' and 'prostatectomy'. Studies included patients with prostate cancer underwent by prostatectomy radical with open surgery (retropubic), laparoscopic or robotic surgery. Results: Ten observational studies with moderate quality and 29 case series with low quality were selected. Observational studies showed lower percentages of erectile dysfunction after intervention in the patients underwent robotic surgery (3–51%). Radical surgery (36–91%) and laparoscopic surgery showed higher values of impotence. In the studies that compared surgery versus radiotherapy, the results were better for radiotherapy (3–72% erectile dysfunction). In the case series, lower percentages of erectile dysfunction were shown in patients underwent to robotic surgery (22%), the following was for laparoscopic surgery (40%) and open radical prostatectomy (41.4%). Conclusions: This result should be considered with caution because of the low methodological quality of the studies included. However, the different surgical techniques assessed showed similar effects in the two types of studies included and we found that robotic surgery presented lower percentages of sexual impotence (AU)

[Use of guar gum as a supplement to the usual diet in type 2 diabetes. A long-term study]. / Utilización de la goma guar como suplemento de la dieta habitual en diabéticos tipo II. Estudio a largo plazo.

The effects of diet supplementation with guar rubber in granules (15 g/day, divided in three doses with the major meals) were compared during 3 months with a control group in a randomized study. Thirty-five type II diabetic patients were randomized into two groups (guar and control) of 16 and 19 patients, respectively. The patients in the guar group showed an improvement in the carbohydrate and lipid metabolism as compared with the control group; however, in our opinion, this improvement was not important enough to recommend the routine use of guar rubber in the diet of the diabetic patient owing to its poor acceptance.

Evaluación de la vacuna pandémica antigripal A/H1N1 adyuvada MF59. Revisión sistemática de la literatura / Assessment of the MF59-adjuvanted pandemic influenza A/H1N1 vaccine. Systematic review of literature

Objetivo: Evaluar la eficacia y la seguridad de la vacuna adyuvada MF59 en la gripe pandémica en población infantil. Métodos: Se ha elaborado una revisión sistemática de la literatura médica (2005-2012). Para ello se realizó una búsqueda bibliográfica en fuentes de datos electrónicas como MedLine o Embase y búsqueda manual en revistas especializadas, utilizando descriptores MeSH y términos de búsqueda libre. Los criterios de inclusión fueron ensayos clínicos que incluyeran a niños vacunados frente a la gripe A/H1N1 con la vacuna adyuvada MF59 y se comparaba frente a otras dosis vacunales con o sin adyuvante MF59, registrando resultados de seguridad e inmunogenicidad. La calidad de los ensayos clínicos se evaluó utilizando los criterios del cuestionario CASPe. Resultados: Se seleccionaron 4 ensayos clínicos de calidad moderada. Los efectos adversos locales y sistémicos fueron de carácter leve o moderado, sin diferencias entre los grupos vacunados. Los porcentajes de seroconversión y seroprotección alcanzados fueron superiores con las vacunas que utilizaron el adyuvante MF59. Los títulos de anticuerpos alcanzados también fueron mayores en las vacunas adyuvadas. Conclusiones: La vacuna pandémica antigripal adyuvada con MF59 presenta un buen perfil de eficacia y seguridad. Los efectos adversos que puede ocasionar son comunes y se presentan de manera similar a los que acontecen al utilizar vacunas no adyuvadas (AU)

Objective: To assess the efficacy and safety of MF59-adjuvanted pandemic influenza A/H1N1vaccine in children. Methods: A systematic review of the literature was performed after searching the MedLine and Embase electronic databases, and manual search in specialties journals, with MeSH terms and free terms. Inclusion criteria were clinical trials with children vaccinated with MF59-adjuvanted influenza A/H1N1 vaccine, compared with other vaccines doses with/without MF59-adjuvanted. The immunogenicity and safety of the vaccine was recorded. The quality of the studies included was assessed by CASPe checklist. Results: Four clinical trials with moderate quality were selected. The local and systemic adverse effects were rare and mild, with no differences between groups. Seroconversion and seroprotection levels were higher with MF59-adjuvanted vaccines. Antibody titres were also higher with the adjuvant vaccines. Conclusions: The adjuvant vaccine has a good efficacy and safety profile. The adverse effects that may occur are common and appear similarly in both vaccination groups (AU)

Evaluación de los métodos rápidos para la detección de Streptococcus pyogenes. Revisión sistemática y metaanálisis / Evaluation of rapid methods for detecting Streptococcus pyogenes. systematic review and meta-analysis

Introducción: La faringitis estreptocócica constituye uno de los motivos más frecuentes de consulta en Atención Primaria y Pediátrica. El tratamiento inadecuado puede conllevar efectos adversos y resistencia bacteriana. Las técnicas de detección antigénica preemitirían el diagnóstico de infección por Streptococcus pyogenes en pocos minutos. Esta revisión pretende evaluar las técnicas rápidas de detección antigénica para el diagnóstico de S. pyogenes a partir de exudado faringoamigdalar. Material y métodos: Revisión sistemática y metaanálisis (2000-2009). Se realizó una búsqueda en las bases de datos MedLine, Embase, Cochrane Library, Cinahl, CRD, ECRI, Hayes y bases de datos de Agencias de Evaluación. La calidad de los estudios se analizó según los criterios QUADAS. Se calcularon los índices de validez diagnóstica y se elaboró un metaanálisis para sintetizar los resultados. Resultados: Se incluyeron 24 estudios de pruebas diagnósticas, de calidad moderada. La sensibilidad estuvo comprendida entre 65,6-96,4%; la especificidad osciló entre 68,7 y 99,3%; el valor predictivo positivo tuvo un rango de 59,4-97,4%, y el valor predictivo negativo entre 87,8-98%. El metaanálisis determinó una sensibilidad global de 0,85 [IC: 0,84-0,87], la especificidad fue de 0,96 (IC: 0,96-0,97), el cociente de probabilidad positivo de 22,21 (IC: 15,12-32,63), y el negativo de 0,15 (IC: 0,13-0,18). La prueba presentó un buen rendimiento diagnóstico. Conclusiones: Las técnicas ofrecen buena respuesta para usarlas como método diagnóstico; sin embargo, estos dispositivos tienen que ser complementados con la realización del cultivo microbiológico debido a la existencia falsos positivos y falsos negativos (AU)

Introduction: Streptococcal pharyngitis is one of the most frequent reasons for consultations in primary and paediatric care. An inadequate treatment could cause adverse effects and bacterial resistance. The rapid antigen tests are an important advance, enabling the diagnosis of infection by Streptococcus pyogenes to be diagnosed in a few minutes. The aim of this review is to assess the rapid antigen-detection test in the diagnosis of S. pyogenes from throat samples. Material and methods: Systematic review and meta-analysis (2000-09). Source database: MedLine, Embase, Cochrane Library, Cinahl, CRD, ECRI, Hayes and HTA's agencies. The quality of included studies was measured according to Quadas’ criteria. The diagnostic validity indices have been calculated. A meta-analysis was performed in order to synthesize the results of the different evaluated studies. Results: Twenty four studies were included. The quality was moderate. The sensitivity ranged between 65.6% and 96.4%; specificity from 68.7% 99.3%; the positive predictive value was between 59.4% 97.4%; and the negative predictive value from 87.8% 98%. The meta-analysis determined an overall sensitivity of 0.85 [95% CI, 0.84 0.87], specificity was 0.96 [95% CI, 0.96-0.97], likelihood ratio (+) 22.21 [95% CI, 15.12-32.63], and likelihood ratio ( ) 0.15 [95% CI, 0.13-0.18]. The rapid antigen-detection test demonstrated a good diagnostic performance. Conclusions: Rapid tests offer good accuracy for use as diagnostic method, however, these devices have to be complemented with the microbiological culture, because there are false positive and negative results (AU)

Endoláser en el tratamiento de patologías venosas en miembros inferiores. Revisión sistemática de la bibliografía / Endovenous laser in thetreament of venous patology in low members. Systematic review of scientific iterature

Objetivo. Evaluar la eficacia y seguridad del láser endovenoso en el tratamiento de la insuficiencia venosa delos miembros inferiores. Materiales y métodos. Diseño: revisión sistemática de la literatura científica. Fuente de datos: Medline (2003-marzo 2008), Embase (2003-marzo 2008), bases mantenidas por el Center for Reviews and Dissemination, Cochrane Library, Red Europea de Detección Precoz de Tecnologías y el registro norteamericano de ensayos clínicos ClinicalTrials.gov. Metodología: se incluyeron pacientes adultos con insuficiencia venosa de miembros inferiores.La intervención consistió en el tratamiento de la insuficiencia venosa mediante la utilización de láser endovenoso en comparación con la cirugía convencional. Como resultados se han elegido parámetros de seguridad (complicaciones y efectos adversos) y eficacia (porcentaje de oclusión de venas y grado de satisfacción del paciente). La calidad se valoró mediante criterios del programa CASPe y Jadad. Resultados. Se seleccionaron cuatro ensayos clínicos, cuatro informes de agencias de tecnologías sanitarias y una revisión sistemática. Los informes de agencias y la revisión mostraron intervalos de eficacia comprendidos entre 87,95 y 100%. Las complicaciones más frecuentes fueron equimosis, induración de la zona, hematoma, parestesias e hiperpigmentación. Los ensayos clínicos presentaban una eficacia del 89,6-98,4% a los tres meses de la intervención y complicaciones menores que en el grupo control. El tiempo de recuperación era menor en el grupo intervenido con endoláser y la satisfacción del paciente mayor. Conclusiones. La tecnología endoláser se presenta segura, con reacciones adversas típicas de intervenciones quirúrgicas, pero menores que con la cirugía convencional(AU)

La eficacia presenta en general porcentajes altos, aunque según aumenta el tiempo transcurrido desde la intervención, disminuye y se iguala con la cirugía convencional. La gran ventaja de esta técnica puede residir en el tiempo de recuperación y las molestias postoperatorias, que son menores que en la cirugía convencional(AU)

Aim. Assessment the efficacy and safety of endovenous laser in the treatment of venous insufficiency of lowmembers. Materials and methods. Design: systematic review of scientific literature. Source database: MedLine (2003-March 2008), Embase (2003-March 2008), Center for Reviews and Dissemination, Cochrane Library, European Agencyof Medicine, European Network of Early Detection of Technologies and the registry of clinical trials ClinicalTrials.gov.Methods: Inclusion criteria: adult patients with venous insufficiency of low members. Intervention: to treat venousinsufficiency by endovenous laser versus conventional surgery. Outcomes: safety parameters (complications and adverseeffects) and efficacy (% occlusion of veins and degree of satisfaction of patients). The quality was assessment by criteriaof the program CASPe and Jadad. Results. We selected four clinical trials, four reports of Health Technology Agenciesand a systematic review. The reports of agencies and the review showed ranges of efficacy between 87,95-100%. Themost frequent complications were equimosis, induration of the area, bruise, parestesias, and hyperpigmentation.Clinical trials showed an efficacy of 89,6-98,4% to three months of the intervention, and minor complications than insurgical group. Time of recovery and patient satisfaction were better in endovenous laser group. Conclusions. Endovenouslaser appears sure, with typical adverse reactions of surgical interventions, minor in conventional surgery. Theefficacy presents in general high percentages, though the more time pass from the intervention, it decreases the moreequal are the results to conventional surgery. The great advantage of this technology could reside in the recovery timeand postoperatory inconveniences, that are minor that with the conventional surgery(AU)